Vesselle H, Schmidt R A, Pugsley J M, Li M, Kohlmyer S G, Vallires E, Wood D E
Department of Radiology, University of Washington, Seattle 98195 USA.
Clin Cancer Res. 2000 Oct;6(10):3837-44.
Tumor proliferation has prognostic value in resected early-stage non-small cell lung cancer (NSCLC). We evaluated whether [F-18]fluorodeoxyglucose (FDG) uptake of NSCLC correlates with tumor proliferation and, thus, could noninvasively grade NSCLCs (refining patient prognosis and therapy). Thirty-nine patients with potentially resectable NSCLC underwent whole-body FDG positron emission tomography (PET) 45 min after i.v. injection of 10 mCi of FDG. Tumor FDG uptake was quantitated with the maximum pixel standardized uptake value (maxSUV). The lesion diameter from computed tomography was used to correct the maxSUV for partial volume effects using recovery coefficients determined for the General Electric Advance PET scanner. Thirty-eight patients underwent complete surgical staging (bronchoscopy and mediastinoscopy, with or without thoracotomy). One stage IV patient by PET underwent bronchoscopic biopsy only. Immunohistochemistry for Ki-67 (proliferation index marker) was performed on all of the 39 NSCLC specimens (35 resections, 1 percutaneous, and 3 surgical biopsies). The specimens were reviewed for cellular differentiation (poor, moderate, well) and tumor type. Lesions ranged from 0.7 to 6.1 cm. The correlation found between uncorrected maxSUV and lesion size (Rho, 0.56; P = 0.0006) disappeared when applying the recovery coefficients (Rho, -0.035; P = 0.83). Ki-67 expression (percentage of positive cells) correlated strongly with FDG uptake (corrected maxSUV: Rho, 0.73; P < 0.0001). The correlation was stronger for stage I lesions (11 stage IA, 15 stage IB): Rho, 0.79; P < 0.0001) and strongest in stage IB (Rho, 0.83; P = 0.0019). A significant association (P < 0.0001) between tumor differentiation and corrected SUV was noted. FDG PET may be used to noninvasively assess NSCLC proliferation in vivo, identifying rapidly growing NSCLCs with poor prognosis that could benefit from preoperative chemotherapy.
肿瘤增殖在早期非小细胞肺癌（NSCLC）切除术后具有预后价值。我们评估了NSCLC的[F-18]氟脱氧葡萄糖（FDG）摄取是否与肿瘤增殖相关，从而能否对NSCLC进行无创分级（完善患者预后和治疗方案）。39例潜在可切除的NSCLC患者在静脉注射10 mCi FDG后45分钟接受全身FDG正电子发射断层扫描（PET）。用最大像素标准化摄取值（maxSUV）对肿瘤FDG摄取进行定量。利用为通用电气Advance PET扫描仪确定的恢复系数，根据计算机断层扫描的病变直径对maxSUV进行校正，以消除部分容积效应。38例患者接受了完整的手术分期（支气管镜检查和纵隔镜检查，有或无开胸手术）。1例PET显示为IV期的患者仅接受了支气管镜活检。对所有39例NSCLC标本（35例切除术、1例经皮穿刺活检和3例手术活检）进行Ki-67（增殖指数标志物）免疫组织化学检测。对标本进行细胞分化（差、中、好）和肿瘤类型评估。病变大小范围为0.7至6.1 cm。应用恢复系数后，未校正的maxSUV与病变大小之间的相关性（Rho，0.56；P = 0.0006）消失（Rho，-0.035；P = 0.83）。Ki-67表达（阳性细胞百分比）与FDG摄取密切相关（校正后的maxSUV：Rho，0.73；P < 0.0001）。I期病变（11例IA期，15例IB期）的相关性更强（Rho，0.79；P < 0.0001），在IB期最强（Rho，0.83；P = 0.0019）。肿瘤分化与校正后的SUV之间存在显著关联（P < 0.0001）。FDG PET可用于在体内无创评估NSCLC增殖，识别预后不良的快速生长的NSCLC，这些患者可能从术前化疗中获益。
